Open treatment of a scaphoid (navicular) carpal bone fracture, including internal fixation when performed.

Verified May 8, 2026 · 6 sources ↓

Medicare: $669.02
Total RVUs: 20.03
Global, days: 90
Region: Wrist

Drawn from CMSEmednyCgsmedicareAAPC

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 6 cited references ↓

Specify laterality (left or right wrist) in the operative note and on the claim
Document the mechanism of injury — scaphoid fractures typically result from a fall on an outstretched hand
Describe the surgical approach by name (e.g., dorsal, volar, or combined) — do not write 'standard approach'
Confirm fracture pattern, location within the scaphoid (proximal pole, waist, distal), and displacement status
Document all fixation hardware used (screw type, size, number) and placement technique
Record intraoperative fluoroscopy use and note it as integral to the procedure — do not bill separately
If bone graft was used, specify donor site location, volume, and whether it was through the same or a separate incision
Postoperative immobilization plan and follow-up interval to support medical necessity

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

22 Increased complexity 24 Unrelated E/M during global 25 Significant separate E/M 51 Multiple procedures 52 Reduced services 57 Decision for surgery 58 Staged or related 59 Distinct service 76 Repeat, same physician 77 Repeat, another physician 78 Unplanned return — related 79 Unrelated during global 80 Assistant surgeon AS PA/NP/CNS assistant LT Left side RT Right side

What this code covers

Source · Editorial summary grounded in 6 cited references ↓

CPT 25628 covers open surgical treatment of a scaphoid fracture — the most commonly fractured carpal bone — via a wrist incision with direct visualization and stabilization using screws, wires, or other internal fixation hardware when indicated. The code covers the procedure with or without internal fixation; if fixation is placed, it's captured under this same code, not separately.

The 90-day global period applies. That covers the day-before visit, the surgery itself, and all routine postoperative care through day 90. Unrelated E/M services in that window require modifier 24. A separately identifiable E/M on the day of surgery requires modifier 25. Bone graft harvested through the same incision is frequently questioned — document distinctly if a separate graft harvest site is used and whether code 20900 is supported.

Fluoroscopy used intraoperatively to confirm hardware placement is integral to 25628 and is not separately reportable under NCCI bundling principles. Bone graft through a remote donor site may be separately reportable with appropriate modifier and documentation support — confirm with your specific payer, as policies vary.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU	9.43
Practice expense RVU	8.8
Malpractice RVU	1.8
Total RVU	20.03
Medicare national rate	$669.02
Global period	90 days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

Setting	Medicare rate (national)
Office (PFS non-facility) Procedure performed in physician's office	$669.02
HOPD (APC 5114) Hospital outpatient department	$7,413.38
ASC (PI A2) Ambulatory surgical center (freestanding)	$3,695.53

Common denial reasons

The recurring reasons claims for CPT 25628 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

Missing or ambiguous laterality — claim lacks LT or RT modifier when payer requires it
Intraoperative fluoroscopy billed separately, triggering NCCI bundling denial
ICD-10 diagnosis code does not specify scaphoid bone — unspecified carpal fracture codes fail to match 25628 specificity
Upcoding concern when documentation does not confirm open approach — closed treatment (25622/25624) is the correct code if no incision was made
Bone graft billed separately without documentation of a distinct remote donor site and separate incision
Global period violation — postoperative E/M billed without modifier 24 within 90-day window

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 6 cited references ↓

01Does 25628 include internal fixation, or is that billed separately?

Internal fixation is included in 25628. The code covers open treatment with or without fixation — there is no add-on or separate code for the screw or wire placement.

02Can intraoperative fluoroscopy be billed separately with 25628?

No. Per NCCI bundling principles, fluoroscopy used during an open fracture procedure is integral to the surgical service and is not separately reportable.

03What modifier is required when the surgeon only performs the surgery and another provider handles postoperative care?

Use modifier 54 for surgical care only. The co-managing provider bills modifier 55 for postoperative management. Apportion the global period accordingly — verify split-care rules with the MAC.

04Can bone graft harvested at the same operative session be billed separately?

Only if the graft was taken through a separate, distinct incision at a remote donor site. Graft obtained through the same wrist incision is bundled into 25628. Document donor site and incision separately if billing 20900 or similar — payers will audit this.

05Which ICD-10 codes support 25628?

Use S62.001–S62.019 (fracture of scaphoid bone of wrist) with the appropriate 7th character for initial encounter (B for open fracture). Unspecified carpal fracture codes are frequently rejected — code to the highest specificity available.

06If the same surgeon treats a bilateral scaphoid fracture at one session, how is that billed?

Bill 25628 with modifier 50 for a bilateral procedure performed at the same operative session. Append LT and RT if the payer requires separate line items instead. Reimbursement typically does not exceed 150% of the single-procedure allowable.

07What is the global period for 25628 and what does it cover?

25628 carries a 90-day global period covering the day-before visit, the surgery, and all routine postoperative visits through day 90. Unrelated E/M services in that window require modifier 24; a separately identifiable preoperative E/M on the day of surgery requires modifier 25.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira AI Scribe

Mira's AI scribe captures the surgical approach by name, fracture location within the scaphoid (proximal pole, waist, or distal), fixation hardware specifics (screw type and size), laterality, intraoperative fluoroscopy use, and bone graft details including donor site and incision. This prevents the two most common audit flags for 25628: operative notes that omit approach name and grafting notes that fail to distinguish same-incision from remote-donor harvest.

See how Mira captures CPT 25628 documentation